Archives: MRCP Part 2

MRCP2-3830

A 29-year-old male presents to the endocrinology outpatient clinic with a 2-month history of weight loss, palpitations, and increasing anxiety. His GP suspects hyperthyroidism and has referred him for further evaluation. The patient has no significant medical history except for a right orchidopexy at the age of 11 and a fibula fracture sustained while playing football at the age of 13. On examination, he appears anxious with bilateral sweaty palms. His BMI is 13.8 kg/m², and a systolic murmur is heard with a sinus tachycardia of 120 beats per minute. No neck swelling is observed or palpated.

The patient’s blood tests reveal a Hb of 147 g/l, platelets of 278 * 109/l, WBC of 8.9 * 109/l, Na+ of 141 mmol/l, K+ of 3.8 mmol/l, urea of 4.5 mmol/l, TSH of < 0.01 mu/l, free T4 of 33.3 pmol/l (normal 10-24), and beta HCG of 16000 (normal range < 5 mIU/ml for men). What is the most appropriate next investigation?

MRCP2-3832

A 65-year-old gentleman with a history of polycystic kidneys and undergoing haemodialysis for the last six months presented to the renal patient clinic with complaints of increasing shortness of breath on exertion and reduced appetite. His GP had previously conducted investigations and prescribed ferrous sulphate, but the patient did not feel much better. On examination, he appeared pale with a blood pressure of 132/78 mmHg, heart rate of 82 bpm, and respiratory rate of 18/min. Two ballotable masses were noted in the renal angle. Further investigations revealed elevated levels of urea and creatinine. What is the most appropriate next step in management?

MRCP2-3815

A 50-year-old man with type 2 diabetes, hypertension and proteinuria is prescribed ramipril to prevent the development of renal disease. However, he complains to his GP about a persistent cough since starting the medication. He denies any symptoms of lip swelling, wheezing, or underlying respiratory disease. What chemical is believed to be responsible for his cough?

MRCP2-3802

A 52-year-old man presents to the Emergency Department (ED) with ankle swelling and general malaise. He reports a recent decrease in exercise tolerance due to increasing breathlessness and a productive cough. On examination, he has a raised JVP, bipedal oedema, and bi-basal crackles. Investigations reveal an enlarged heart with evidence of fluid overload on CXR, and a dilated left ventricle with moderate global impairment of function on ECHO. Which factor would have the greatest impact on his long-term prognosis?

MRCP2-3811

During an evening on-call, you are summoned to the haematology ward to assess an elective chemotherapy patient. A 24-year-old male is scheduled to begin chemotherapy for Hodgkin’s lymphoma the next day and is complaining of pain in his left flank. He has been under investigation by renal physicians for the past four months due to an unknown cause of deteriorating creatinine. He is a non-regular medication user, smokes about 10 cigarettes daily, and occasionally indulges in marijuana.

Upon examination, you observe bilateral lower limb non-pitting oedema up to the knees. There is a left varicocele and mild bilateral scrotal oedema. His heart sounds and chest auscultation are unremarkable. Abdominal examination reveals only mild left renal angle tenderness. A urine dip reveals 4+ blood, 2+ protein, and normal pH. Upon reviewing his old clinic letters, you discover that a renal biopsy from two months ago showed IgG and complement deposits on the basement membrane.

His current serum results are:

K+ 5.4 mmol/l
Urea 12.8 mmol/l
Creatinine 212 µmol/l
Albumin 18 g/l

What is the most probable acute diagnosis?

MRCP2-3818

A 28-year-old female patient presents with a widespread maculopapular rash accompanied by fever and lower back pain. She has also noticed swelling in both her legs. The patient had visited her GP three weeks ago and was prescribed amoxicillin for a chest infection. A urinalysis was performed, and the results are as follows:

Urinalysis
Blood +++
White cells +++ (eosinophils+++)
No organisms seen
Glucose –
Nitrates –

Blood tests:

Hb 10.6 g/dl
MCV 86 fl
Platelets 390 * 109/l
WBC 9.2 * 109/l

Na+ 136 mmol/l
K+ 4.2 mmol/l
Urea 12.4 mmol/l
Creatinine 135 µmol/l

What is the most probable diagnosis?

MRCP2-3816

You are requested to assess a 26-year-old female patient admitted to the ENT ward. The patient underwent a total thyroidectomy for the management of her Graves’ disease. After a few hours of returning to the ward from the operation theatre, she started experiencing arm twitching. What is the most probable diagnosis?

MRCP2-3814

A 65-year-old man with diabetic nephropathy has started regular haemodialysis and is attending a routine check-up. He is worried about having anaemia after hearing from his friend on haemodialysis. At what point should this patient be evaluated for anaemia?

MRCP2-3813

A 60-year-old man with progressive chronic kidney disease secondary to IgA nephropathy was seen in the nephrology clinic. He reported feeling well except for mild ankle swelling. The following blood tests were obtained:

– Hb: 104 g/L (normal range for males: 135-180; females: 115-160)
– Platelets: 276 * 109/L (normal range: 150-400)
– WBC: 8.2 * 109/L (normal range: 4.0-11.0)
– Na+: 133 mmol/L (normal range: 135-145)
– K+: 5.8 mmol/L (normal range: 3.5-5.0)
– Urea: 18.5 mmol/L (normal range: 2.0-7.0)
– Creatinine: 912 µmol/L (normal range: 55-120)
– eGFR: 5 mL/min/1.73 m² (normal range: >60 mL/min/1.73 m²)
– Bicarbonate: 17 mmol/L (normal range: 20-28)
– Calcium: 2.05 mmol/L (normal range: 2.1-2.6)
– Phosphate: 1.8 mmol/L (normal range: 0.8-1.4)

Based on this information, it was decided that he needed to start dialysis. What is the most likely reason for initiating dialysis in this case?

MRCP2-3812

A 25-year-old female presents to her general practitioner with a 2 week history of fevers, lethargy, and weight loss. She also complains of painful eyes and visual disturbance. She has no past medical history and is not taking any medications.

On examination, her blood pressure is 130/78 mmHg and heart rate is 100 bpm. Her temperature is 37.9ºC. Both eyes are red, with conjunctival injection. Urinalysis shows protein 2+ and leukocytes 3+.

Hb 108 g/L Male: (135-180)
Female: (115 – 160)
Platelets 438 * 109/L (150 – 400)
WBC 13 * 109/L (4.0 – 11.0)
Na+ 142 mmol/L (135 – 145)
K+ 4.8 mmol/L (3.5 – 5.0)
Urea 17 mmol/L (2.0 – 7.0)
Creatinine 320 µmol/L (55 – 120)
CRP 87 mg/L (< 5) What is the most likely diagnosis?